Head / Face
Masticatory Muscle Myofascial Pain
저작근 근막통증
Masseter/medial pterygoid trigger points referring pain to jaw, face, ear, temple
- How common
- 5–12% of adults
- Typical age
- Ages 20–40, female>male
What is it?
Bruxism/clenching/stress drive masseter and medial pterygoid overactivity with trigger point formation and trigeminal-distribution referred pain.
Commonly affected: Masseter, medial pterygoid (sometimes lateral pterygoid)
How it develops
- Muscle OveractivityClenching/bruxism sustain contraction
- Local IschemiaReduced blood flow creates energy crisis
- Trigger Point FormationContraction knots and taut bands develop
- Referred PainTrigeminal sensitization refers pain to ear/temple
Symptoms
- Deep cheek/jaw painDull aching quality
- Referred ear/temple painOften deep ear pain
- Limited mouth openingTypically <35 mm inter-incisal
- Worse with chewingWorse with hard foods
- Morning jaw fatigueAssociated with nocturnal bruxism
How it is examined
- Masseter TrP palpationPalpation of nodule in taut band reproduces referred pain
- Medial pterygoid tendernessIntraoral palpation along medial ramus
- Inter-incisal openingMaximal opening (normal 40–55 mm)
- DC/TMD criteriaDiagnostic Criteria for TMD — myofascial pain
Imaging
Dental panoramic/CBCT exclude TMJ osseous pathology; muscle not visible on X-ray.
- Normal condylar surface
- No osseous change
- Evaluates dentition/jaw
US useful for trigger points/taut bands; MRI rules out TMJ disc pathology.
- US: hypoechoic nodules within masseter
- MRI: TMJ disc usually normal
- No joint effusion
Non-surgical care
- Jaw rest/habit reversalClench awareness, soft diet 2–4 weeks
- Heat/stretchingMoist heat followed by active jaw stretching
- Occlusal stabilization splintNight guard for bruxism
- TrP injection/dry needlingInjection or dry needling for persistent TrPs
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
No surgical indication (unless TMJ pathology coexists)
Procedures that may be discussed
- Conservative care only
Outlook
Most resolve in weeks-months; stress management prevents recurrence.